From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore. Dr. Baldessarini is now with the Department of Psychiatry, Massachusetts General Hospital, Boston.

LITHIUM salts have been used widely since their introduction to psychiatry by Cade of Australia in 19491 for the treatment of manic and agitated states. Although there have been a growing number of reports of the use of lithium salts in America2-6 since their introduction here in 1960,7 much more experience with lithium salts has been acquired in Europe and Australia.8-12 This form of treatment appears to be of benefit for mania and excitement and less useful in other forms of psychosis, including schizophrenia and psychotic depression.5,6,10,11,13,14 There is suggestive evidence, too, that lithium salts may reduce the severity and probability of recurrence of both elations and depressions in certain patients with periodic mood disturbances.13,15,16

The slow and limited acceptance of lithium salt therapy by American psychiatrists appears to have been influenced by several factors. These include a